Elder care: Trading places with your parents
Someday mom and dad could become financially and
emotionally dependent on you. Are you ready?
"The chronic problems of aging don't lend themselves
to quick fixes," warns Norman Hannay, president of House Calls Homecare,
a geriatric care management company in La Jolla, Calif. "You can't
go into surgery for dementia. You can't reverse osteoporosis. It's
very difficult to rehabilitate functional loss."
As the general population of America starts to gray
and baby boomers begin to retire, children of aging parents find
themselves in a difficult situation -- balancing their own lives
while trying to provide care for the people who gave them life.
Today, about 6.5 million people require some type of assistance
-- either in the home or in a nursing facility -- and 22 million
families are providing care for an older relative, according to
the National Alliance for Caregiving.
A rock and a hard place
This assistance -- from placing a parent in a nursing
facility to setting up home health care to taking over for the parent
financially -- can easily become an enormous monetary and emotional
strain on the entire family. Marriages can be destroyed and families
can find themselves fighting over what exactly should be done and
who should take action.
"You are conflicted because you want to take care
of an aging parent, but it takes an emotional toll," explains Joyce
Gioia, a certified management consultant and president of the Herman
Group, in Greensboro, N.C. Gioia has witnessed first-hand the burden
placed on her two daughters, who provide care for Gioia's ailing
ex-husband. "It's a real strain for them to go there and be with
him, because he doesn't want to get better. Their father doesn't
want to take care of himself."
Erica Karp, a licensed clinical social worker for
Northshore Eldercare Management Inc. in Northbrook, Ill., helps
families cope with the strain of taking care of an aging parent.
"Often, I am hired by adult children, and often the
family is in a crisis situation," she says. "The family is concerned
because the older person has changed somehow."
When a family comes to Karp, she assesses the situation
with both the family and the person in need. Karp then presents
a recommended plan of care, and the family will either decide to
follow her suggestions on their own or have Northshore take action.
Charges for the initial consultation vary depending on the complexity
of the situation, but averages out to about $350.
"Most people want to do what is best for the parent,
but they are not sure what that is," she acknowledges.
Loraine Sailor, office manager for Children of Aging
Parents, a nationwide support group based in Levittown, Pa., recommends
working the parent into the decision-making process by presenting
alternatives to the current situation. For example, if a parent
needs help with daily chores such as eating and dressing, an aide
can be brought into the home. Or if the parent suffers from loneliness,
say from the death of a spouse, adult day care programs give the
elderly the opportunity to be supported by others in similar situations,
as well as a place to participate in activities that they gave up
on long ago.
"When communicating with an older parent, don't treat
them as children and talk down to them," Sailor recommends.
"Try and keep lines of communication open," advises
Francine Lynch, director of programs for the Equitable Foundation
in New York. "Without a good relationship, these issues become even
more complicated. Take your time; if your parent doesn't respond
to your suggestions, give it a rest and try again later."
If the parent suffers from Alzheimer's disease or
dementia, the child must understand that they are not dealing with
a rational thinking person.
"At all costs, don't argue with them," she explains.
"Appease them. If the parent is confused, puts on their hat and
says that they're going to the mall, say to them, 'OK, why don't
we wait a few minutes, and I'll go with you?' The parent will agree
and forget a few minutes later what they had in mind.
"Most people fear their parents hating them. But you
have to show them tough love."
Preventing a financial crisis
Another fear that comes into play for families is
affording the cost of eldercare. Many senior citizens on fixed incomes
see their nest eggs dry up as they bear the brunt of the cost of
caring for themselves. A 24-hour home health care worker will charge
a rate of around $100 a day and nursing home costs can be devastating.
"The average length of time for a person in a nursing
home to spend down their assets is less than one year," says House
Once a person is down to the poverty level, the only
option left is living off of Medicaid. But what steps can be taken
now to prevent someone, even currently healthy parents, from
winding-up in a Medicaid-supported situation, due to a debilitating
"Simply make sure that your parents have long term
care insurance," stresses Gioia.
Long term care insurance provides for the cost of
a prolonged situation of need, whether it's in the home, a nursing
home or assisted living facility. Hannay says that premiums range
from $1,000 to $10,000 per year, depending on your age and pre-existing
conditions. Look for a policy that provides coverage in the largest
number of scenarios, including assistance in cooking, dressing and
cleaning. Also, a good LTC policy offers a high payment for services.
"In California, it costs $80 a day to get a worker
in the home," explains Hannay. "If the policy covers $40 a day,
it doesn't do much good."
Search for a program that lasts for the length of
time that coverage may be needed. Some plans are good for a policyholder's
"Alzheimer's patients can live a long time," he warns.
If the person is unable to afford long term care,
here are some other options, as suggested by the experts interviewed:
Cashing in a life insurance
policy while the parent is still living -- policies other than
term insurance build up cash value, if a person wants to surrender
the death benefit.
If there is a lot of equity
in a parent's home, a home equity loan or a reverse mortgage
may be a way to supplement income. Reverse
mortgages pay the recipient a monthly income for life based
on the amount of equity built into the home. The parent is allowed
to remain at home, and the bank sells the house after the owner
dies. Reverse mortgages are available for people 65 and older
and are not considered taxable income.
If the financial situation
is dire, the sale of the parent's home can pay for medical needs.
Sales can be made legally within the family at fair-market value
prices, thus allowing the parent to remain at home and not be
forced into a nursing home or move-in-with-the-children situation.
Contact your employer's benefit
department to see what help may be available to you. For example,
some companies are providing for eldercare in the workplace,
says Hannay. Similar to onsite child care, an employee drops
off the parent in an adult care facility located at their place
of work. Meanwhile, American Express offers eldercare referral
services to its employees as part of its "Work-Life Initiative."
Finally, CAPS offers an excellent
guide to dealing with eldercare called "The Equitable Foundation's
Guide to Aging Parents and Common Sense." The booklet lists
agencies to contact and advice on coping with situation. If
you would like to order a copy, contact CAPS at (800) 227-7294.
-- Posted: April 30, 1999